title: Effects of vertical muscle surgery on differences in the orientation of Listing's plane in patients with superior oblique palsy.
abstract: BACKGROUND
  Although scleral search coils are widely and accurately used for the measurement of Listing's plane in both eyes, they require specialized equipment and are invasive. In this study, we describe a convenient and less invasive method that uses a synoptometer to analyze the differences in orientation of Listing's plane (difLP), and the effects of vertical muscle surgery on the difLP tilt in patients with superior oblique palsy (SOP).
  
  
  METHODS
  Seventeen patients with unilateral congenital SOP (CSOP) and four patients with unilateral acquired SOP (ASOP) who had not undergone any strabismus surgeries were examined. Cyclodeviations of 13 vertical and horizontal gaze points within 30° were measured with a synoptometer, and the difLP tilts in the yaw and pitch planes were analyzed before and after vertical muscle surgery.
  
  
  RESULTS
  The difLP tilt in the CSOP patients was significantly tilted nasally (p = 0.02) and forward on the lower side (p = 0.001), whereas that in ASOP patients tended to tilt temporally (p = 0.15). Ipsilateral inferior oblique recession (IOR) performed in seven CSOP patients tended to improve the difLP tilt in both the yaw (p = 0.07) and pitch (p = 0.09) planes, whereas contralateral inferior rectus recession (IRR) performed in three CSOP patients significantly improved the difLP tilt in the pitch plane (p = 0.015). The mean excyclodeviations in the 13 gaze points were significantly improved with both procedures (p < 0.0001 for both).
  
  
  CONCLUSIONS
  The difLP tilt in the SOP patients could be analyzed with a convenient and less invasive method using a synoptometer, and dissimilar difLP tilts were confirmed in the ASOP and CSOP patients. The results of this study suggest that both IOR and IRR are reasonable treatments for improving the difLP tilt in CSOP patients. IOR should be selected for patients with a steep preoperative difLP tilt to the nasal side, whereas IRR should be selected for patients with a gentle preoperative difLP tilt.
authors.forename: Manabu
authors.initials: M
authors.lastname: Miyata
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Shira
authors.forename: Reika
authors.initials: R
authors.lastname: Kono
authors.forename: Ichiro
authors.initials: I
authors.lastname: Hamasaki
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hasebe
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ohtsuki
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003941:Diagnostic Techniques, Ophthalmological; D005133:Eye Movements / Q000502:physiology*; D006801:Humans; D008875:Middle Aged; D009801:Oculomotor Muscles / Q000503:physiopathology* / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures; D013285:Strabismus / Q000503:physiopathology / Q000601:surgery*; D014102:Torsion Abnormality / Q000503:physiopathology*; D020432:Trochlear Nerve Diseases / Q000151:congenital / Q000503:physiopathology / Q000601:surgery*; D015357:Vision Disparity / Q000502:physiology*